Cade Thomas J, Gilbert Stacey A, Polyakov Alex, Hotchin Anne
Department of Obstetrics and Gynaecology, Geelong Hospital, Geelong, Victoria, Australia.
Aust N Z J Obstet Gynaecol. 2012 Apr;52(2):179-82. doi: 10.1111/j.1479-828X.2011.01409.x. Epub 2012 Feb 15.
The gold standard for diagnosis of proteinuria in pre-eclampsia is traditionally a 24-h urine collection. Current Australian guidelines advocate use of the spot urine protein-to-creatinine ratio (PCR); however, there is controversy in the international literature about its accuracy and little recent Australian data exists.
To clarify the accuracy of the spot urine PCR in a cohort of Australian women with pre-eclampsia.
Women with pre-eclampsia over a 52-month period from a single obstetric unit were included in the study. Spot urine PCR, 24-h urine collection, gestation at delivery, severe hypertension in labour and magnesium sulphate requirement were recorded. Primary analysis of predictive values was performed on women who had had both a spot urine PCR and a 24-h collection. Continuous data were assessed using least squares analysis with Pearson correlation coefficient, Bland-Altman plot and receiver operator characteristics curve.
Two hundred and seventeen women had pre-eclampsia, and 121 of these underwent both tests. The two tests were highly correlated (r = 0.98, P < 0.0001). The urine PCR had a positive predictive value of 94% and a sensitivity of 95% for predicting proteinuria. There were no significant increases in the diagnosis of severe hypertension in labour nor the need for magnesium sulphate infusion in labour in those women in whom the 24-h collection was omitted.
The urine PCR is highly accurate in predicting significant proteinuria in women with pre-eclampsia using the recommended cut-off of 30 mg/mmol. Our findings support current guidelines suggesting the use of a 24-h urine collection is now rarely required.
传统上，子痫前期蛋白尿诊断的金标准是24小时尿蛋白定量。澳大利亚现行指南提倡使用随机尿蛋白与肌酐比值（PCR）；然而，国际文献中对于其准确性存在争议，且近期澳大利亚相关数据较少。
明确随机尿PCR在澳大利亚子痫前期女性队列中的准确性。
研究纳入了来自单一产科单位、在52个月期间患有子痫前期的女性。记录随机尿PCR、24小时尿蛋白定量、分娩时孕周、产时重度高血压及硫酸镁使用情况。对同时进行了随机尿PCR和24小时尿蛋白定量检测的女性进行预测值的初步分析。连续数据采用最小二乘法分析，计算Pearson相关系数、绘制Bland-Altman图及受试者工作特征曲线。
217名女性患有子痫前期，其中121名进行了两项检测。两项检测高度相关（r = 0.98，P < 0.0001）。尿PCR预测蛋白尿的阳性预测值为94%，敏感性为95%。对于那些未进行24小时尿蛋白定量检测的女性，产时重度高血压的诊断及产时硫酸镁输注的需求并无显著增加。
使用推荐的30mg/mmol临界值时，尿PCR在预测子痫前期女性显著蛋白尿方面具有高度准确性。我们的研究结果支持当前指南，即现在很少需要进行24小时尿蛋白定量检测。
